<p>Arterial Stiffness Increases Over Time in Relation to Lung Diffusion Capacity: A Longitudinal Observation Study in COPD</p>

Abstract

Background: Cardiovascular events are, after cancer, the most common cause of death in COPD patients. Arterial stiffness is an independent predictor of all-cause mortality and cardiovascular events. Several cross-sectional studies have confirmed increased arterial stiffness in patients with COPD. Various mechanisms in the development of arterial stiffness in COPD such as reduced lung function or systemic inflammation have been proposed. However, clinical predictors of arterial stiffness that had been reported in cross-sectional studies have not yet been confirmed in a longitudinal setting. We have assessed the course of augmentation index (AIx)-a measure of systemic arterial stiffness-and possible predictors in a cohort of COPD patients over a period of up to 7 years. Methods: COPD patients underwent annual AIx measurement by applanation tonometry for a maximum duration of 7 years. Additionally, we performed annual assessments of lung function, blood gases, systemic inflammation, serum lipids and blood pressure. Associations between the course of AIx and potential predictors were investigated through a mixed effect model. Results: Seventy-six patients (mean (SD) age 62.4 (7.1), male 67%) were included. The AIx showed a significant annual increase of 0.91% (95% CI 0.21/1.60) adjusted for baseline. The change in diffusion capacity (DLco), low-density lipoprotein (LDL), and high-sensitivity c-reactive protein (hsCRP) was independently associated with the increasing evolution of AIx (Coef.-0.10, p<0.001, Coef. 1.37, p=0.003, and Coef. 0.07, p=0.033, respectively). Conclusion: This study demonstrated a meaningful increase in arterial stiffness in COPD over time. A greater annual increase in arterial stiffness was associated with the severity of emphysema (measured by DLco), systemic inflammation, and dyslipidaemia. Clinical Trial Registration: www.ClinicalTrials.gov, NCT01527773.

Arterial stiffness can occur early in mild-to-moderate chronic obstructive pulmonary disease

“…The researchers assessed the arterial stiffness of the included patients by annual measurement of the AIx over a period of 7 years and concluded a significant increase in arterial stiffness in their patients' overtime. Moreover, the amount of annual increase in AIx was correlated to the severity of emphysema [12]. On the other hand, pulmonary rehabilitation was found to have a possible role in modification of elevated aortic stiffness in a subgroup of COPD patients [24].…”

“…Cardiovascular events were found to be the second most common etiology of mortality following bronchogenic carcinoma in COPD patients [12]. The early affection of the cardiovascular system is important to solve the mystery of such a disease, which is now documented to have a wide range of systemic impact on the whole body.…”

The association between carotid-femoral pulse-wave velocity and lung function in the Swedish CArdioPulmonary bioImage study (SCAPIS) cohort

“…The association between D LCO measures and arterial stiffness has been investigated in COPD patients [26] where arterial stiffness as indirectly measured by the J o u r n a l P r e -p r o o f augmentation index in COPD patients has been related to the severity of emphysema as measured by D LCO [26]. Additionally, greater arterial stiffness as measured by aortic PWV was found in COPD patients with mild disease and was related to the emphysema burden and low D LCO , regardless of FEV 1 impairment.…”

Comparison of arterial stiffness and ultrasound indices in patients with and without chronic obstructive pulmonary disease

“…Cardiovascular disease is the most common chronic disease associated with COPD, a major cause of hospitalization, and also one of the leading causes of death 4 . Previous studies have shown that patients with COPD are at increased risk of atherosclerosis, and the mechanism may be related to hypoxemia and inflammation [5][6][7] . Arterial stiffness is highly relevant to cardiovascular disease and is an important arterial phenotype and an excellent indicator of cardiovascular morbidity and mortality.…”

“…Arterial stiffness is highly relevant to cardiovascular disease and is an important arterial phenotype and an excellent indicator of cardiovascular morbidity and mortality. In clinical practice, measurements of arterial stiffness is currently one of the most commonly used methods to predict cardiovascular risk in patients with COPD 5,7,8 . Of note, early evaluation of arterial stiffness in patients with COPD is of great significance for the treatment and prognosis of the disease.…”